By Leslie Kim Thirty Years And Counting It’s 1986 and individual companies in Southern California, the recognized birthplace of staged auto …

A DOG’S TAIL By K. Charles Spaniel I am a dog; to be more specific, I am a pedigreed Cavalier King Charles …

TARGET: LIFE INSURERS By Kimberly B. Face, Staff Gone are the days of costly divorces. Gone are the days of “I’m dying; …

MONEY LAUNDERING: NGO’S AND CHARITIES By L. Burke Files NGO’s and Charities have slowly evolved, under the radar, to become significant channels …

MEDICAL REVIEWS: SEARCHING FOR NEEDLES IN THE HAYSTACK By Adolpho Nunez-Guererra, M.D. Last night, taking a break from the never-ending stack of …

From the Editor

May 12, 2015

The final insertion to any John Cooke Fraud Report copy is always the editorial. It’s written almost on the way to the …

By Stephen Mason, PhD Insurance fraud is rarely a crime of impulse. Although I am not signifi- cantly closer to thoroughly understanding …

The Blue Cross and Blue Shield Association (BCBSA) is stepping up (Ii w,i, on health care fraud —naming David Ignatius, a seasoned …

Understanding the naming conventions of other cultures is important for an investigator or for anyone wishing to certainly and correctly identify people …

Percentage-wise, it is the fastest growing form of fraud. The National Consumer League’s Internet Fraud Watch results for 1999 are in … …

Donna Gallagher is a tough cookie. But she has to be tough because she manages the Fraud Investigation Program (FIP) for the …

The Employment Development Department, the Franchise Tax Board, the Department of Industrial Relations and the Contractor’s State License Board combined forces and …

NYAAIF. New initials in the fight against insurance fraud. It stands for the New York Alliance Against Insurance Fraud and was founded …

The Insurance Bureau of Canada’s Coalition Against Insurance Fraud, after estimating the cost of fraud to each policyholder at about $150, set …

Mutual of Omaha began taking a special look at medical claims being presented on behalf of employees at the MGM Grand Hotel …

By Barry Zalma Louise Rosenberg lived very well, and alone, in beautiful Marin County, California. She had earned an exceptional living as …

It was Code 90844 that heavily figured in the guilty verdict. To bill this level of service, a psychiatric patient must be …

Companies may not be too happy about the latest in mega-judgments levied against an insurer. A Los Angeles Superior Court handed down …

The Mystery was Solved and Justice Prevailed The crooks name was Marcus Fontaine. Investigators who’ve been around for awhile might remember the …

By L. Burke Files Identity theft is a growing concern. It is a growing concern because it is a growing crime. It …

In a survey of 169 medical doctors (Archives of Internal Medicine), 73 percent said they would lie to get treatment for a …

There’s a new law that will hopefully make computer hackers think twice before they willfully spread a virus. ‘Iltey are now subject to …

Sylvia Mitchell did not let ‘a simple little problem get in the way of her marriage to 85year-old Andrew Vlasto of Las …

By: Jon E. Crosby, CFE, FCLS The late Jack Webb, star of the 1950s and 1960s television series Dragnet, made famous the …

By Kelly E. Riddle There are many court cases on record that affect the way private investigators conduct surveillance. The cases listed …

By Brett Hooker, CIFI Having recently returned from a vacation in northern Illinois, a vacation that included a trip to Comiskey Park, …

Southern California has a new system to allow drivers to whiz past all the traffic and get where they are going much …

By Leslie Kim, CFE What’s happening north of the border in the fraud world? “We’re experiencing the loss of many high end …

WebSPIN

February 18, 2014

FROM OUR RESEDENT ALIKIM TECHNO-GEEK By Dorothy Montague It really happened folks. Yes it is now the 21st Century not the 20th …

THE HISPANIC POPULATION IS GROWING BY LEAPS AND BOUNDS WITH IMMIGRANTS ARRIVING FROM ALL PARTS OF LATIN AMERICA. SINCE WE PUBLISHED THE …

VOLUNTEERED: $285,000 BIG ONES A Roxbury hospital has agreed to pay more than $250,000 in restitution to the state’s Medicaid Program, to …

Sunshine State Mortgage Cheat Busted Federal authorities allege that James Christianson was the top man in a rip-off scam which operated under …

The Claims Details run the gamut. Self-employed California man hospitalized with cardiac arrest and massive Myocardial infarction in Dhaka, Bangladesh. Retired …

STUPID Claimant Tricks

February 18, 2014

In December 1991, a man was hired to torch a house in the San Diego area. After extinguishing all the pilot lights …

Dear Sherry

February 18, 2014

Dear Sherry Q: Recently I was assigned a claim on a slip and fall at a bank. The injuries were severe and …

By D. Michael Bush So far, there have been no new bills introduced for the next session that involve insurance fraud in …

Gotcha!

February 18, 2014

Two former officers of Twentieth Century Life Insurance Company have been indicted in Florida. The two are suspected of diverting almost $9.7 …

Clinique Cam Thach, a Westminster, CA, cosmetic surgery clinic, was run by Elizabeth Cam Thach Thi Le. The clinic did big business …

HOT TIP

February 18, 2014

By Roger Trent Fraud investigators have become proficient at decoding social security numbers; ascertaining in what locale and in what year the …

NHCAA ANNUAL CONVENTION

February 18, 2014

NEW ORLEANS, LOUISIANA NOVEMBER MBER 13-16, 1994 By Susan E. Clarke Meeting the Challenge of Change was the theme for this years …

When a claim report for an automobile fire is made, it is very important to treat the claim as legitimate to avoid …

SAN JOAQUIN COUNTY, CALIFORNIA By Robert Kegel San Joaquin County, in central California, is not the place to go these days if …

By Paul Bigley In recent years we have seen a tremendous increase in “double-dipping,” and in many cases even “triple-dipping,” with regard …

Around the Country

February 18, 2014

California Several bills passed by the legislature were considered by Governor Pete Wilson. Wilson’s veto of one bill, the “Homeowners Bill of …

THE ELEVENTH COMMANDMENT By Susan E. Clarke An investigation conducted by the Kentucky State Police, the U.S. Postal Service, and the U.S. …

By Eric Tackett Investigative medical audits are, without question, one of the most effective and yet one of the most under-used tools …

Fishing for Fraud

February 18, 2014

“And what other treatment did the doctor give you for your LEFT KNEE, Joe?” There’s nothing more gratifying than having Joe Claimant …

DESK TOP INVESTIGATING Understanding the naming conventions of other cultures is important for an investigator or for anyone wishing to certainly and …

By Paul Conway Recently I came across a document that I will refer to as Counsel for Doctor Sues. This is a …

Phoenix Auto Scams Come to a Screeching Halt By Susan E. Clarke A multimillion dollar insurance fraud ring in the Phoenix area was …

SE HABLA ESPANOL? PARLEZ VOUZ FRANCAISE?  SPRECHEN SSE DEUTSCH? By Margie Stern FACTS The United States grants legal immigration status to more …

By Leslie Kim White sand beaches Flower scented breezes T-back bikinis Sunshine Wind-surfing Fresh seafood Rampant insurance fraud… Mike Anderson moved to …

Letter to the Editor

February 17, 2014

In observing the sentences being handed down for insurance fraud crimes, I cannot help but wonder at the reason for the imbalance …

Best Headline Bloopers Something Went Wrong in Jet Crash, Expert Says Police Begin Campaign to Run Down Jaywalkers Safety Experts Say School Bus …

The accusations are damning. Michael, Keen is alleged to have gone boating in November, 1981, with his pregnant wife, Anita, and his …

It had to happen. The nationwide epidemic of litigation fever has spawned an explosion of lawsuits against attorneys, pushing legal malpractice rates …

                                          …

In keeping with their reputation as the feistiest little fraud-fighting county in the state of California (Editor’s Note: and we’d put ’em …

In a certain building located in LA’s 6000 block of Wilshire Boulevard, PI attorney Jeremiah Slimebag shared an office with his deaf …

Dear Sherry

February 17, 2014

Dear Sherry During the past year, as questions about investigations have been submitted to me for this column, several questions seem …

ARIZONA Gregory Enswiler, a 31-year-old, Arizona construction worker, is not a happy camper. He recently had the dubious honor of being the …

A Sacramento man had an inborn talent for making up stories to support the various claims he filed. In 1991 he sued …

Indianapolis, IN — The National Association of Mutual Insurance Companies released a new fraud video series designed to help insurance companies identify …

Understanding the naming conventions of non-European cultures is important for an investigator or anyone wishing to certainly and correctly identify people in …

So, there you are, stuck at your desk in Wisconsin, when you receive a suspicious claim originating in Alabama. What should you …

It could have been worse … way worse. Francois C. Maisonneuve could have been sentenced to five years in jail and fined …

By Diane Kellner Arab World The incidence of fraudulent death claims in the Middle East is increasing. Countries in this area of …

By D. Michael Bush A couple of weeks ago, I attended a seminar given by a chiropractor on how a chiropractor can …

The Phantom Rolls Royce

February 15, 2014

INSURANCE JOURNAL REPRINT By Barry Zalma In California and several other states, before a car can be insured, the agent must photograph …

By Dan King If the investigator compares “Appendix C” and determines that the group numbers have not been issued or are out …

HEY, BABY, WHAT’S YOUR SOCIAL SECURITY NUMBER? Editor’s Note: In our May/June 1994 issue, we published an investigative “HOW-TO” guide to social …

HOT TIP

February 15, 2014

How much does the average company pay for all those record searches ordered through information brokers? Would you be surprised to know …

It was truly a family affair, and an astounding one at that! Mom is Diane Jackson, owner of a home health care …

Stupid Fraudster Tricks

February 15, 2014

Once upon a time Arthur Ramirez owned a white 1992 Thunderbird. It was financed through the Ford Motor Credit Corporation and insured …

Trouble is, the sexily attired bicycle rider was a guy! But wait, it gets better … Kelly Strain, a 33-year-old air-conditioning installer, …

Letter to the Editor

February 15, 2014

In observing the sentences being handed down for insurance fraud crimes, I cannot help but wonder at the reason for the imbalance …

SOME CROOKS ARE DOCTORS; SOME DOCTORS ARE CROOKS By Michael J. Stahl, D.C. Stephen M. Foreman, D.C. Real doctors are often asked …

By Bill Kizorek and Scott Finger Identifying fraudulent activity is just one part of the overall duty of the special investigator. To …

Off the Wall Lawsuits

February 14, 2014

In 1964, a San Francisco attorney represent­ed a woman who claimed to have been in­jured by a cable car. The lawyer claimed …

By John H. Wood There is a wealth of knowledge available from a wide variety of computer databases around this country that …

RECIPE FOR FRAUD The recipe requires a heavy dose of real live customers recruited as policy buyers, however in this particular scam …

EVEN THE ENLIGHTENED CAN FALL PREY By John Garrison, CPCU You ride a desk on the inside of the insurance industry. However, …

TOO JUICY FOR JUST A GOTCHA The woes of Ophthalmologist (oops, make that now FORMER Ophthalmologist) Joseph Mermelstein began almost ten years …

GOTCHA!

November 26, 2013

CALIFORNIA There is more money in Medicare fraud than there is in preaching, or so discovered Charles Agbu and his daughter Obiageli …

MISSOURI TRAGEDY In a family’s cooperative plot that went horribly wrong, 15-year-old Zachariah Kemper burned to death because he could not escape …

FILE THIS IN THE “STUFF I NEED TO KNOW” BOX Each facility will have a list of approved acronyms, abbreviations, and symbols. …

Dr. Arthur Porter has quite a story. Originally born in Freetown, Sierra-Leone, Porter was educated in Africa and at Cambridge, Harvard and …

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STOOOPID CLAIMANT TRICK

November 26, 2013

How can a guy who spent about 14 years in medical school have such pathetic math skills? Dennis Barson, a neurologist from …

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A Dilly in Philly

November 26, 2013

SEPTA DOES NOT STAND FOR “SEE ‘EM PAY THE ACCIDENT” Lance Henderson was not a happy camper when his supermarket slip-and-fall claim was …

PLAYING FOOTSIE WITH MEDICARE Straight out of Guilford, Connecticut, we have Podiatrist Richard Sockoff, oops, we mean Sokoloff, who has plead guilty …

SEVEN PICTURES ARE WORTH A THOUSAND LIES Bryan Gilbert Robb’s smartphone was smarter than he was. After reporting a burglary at his …

FIREBUGS GO WILD in CA, NY and WI “Hang down your head Bill Bailey, hang down your head and cry. Hang down …

Hats Off

November 26, 2013

… to John Romero, upon his retirement from the top spot in the Lawrence, Massachusetts, police department. Romero was the power behind …

Sacred Heart Horror Story

November 26, 2013

SLASHING THROATS FOR THE SAKE OF PROFIT It is a story of secret recordings, bloodcurdling accusations, and exactly how far a for-profit …

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A NEW DIRECTION IN AUTO CLAIMS By Lou Stanley Fraud fighters are constantly looking for new approaches to old problems and old …

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The Great Jewel Theft

November 26, 2013

By Barry Zalma The story that follows is based on fact. It is, however, a work of fiction. The names, places and …

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HEEERE’S DOCTOR BOB …

November 26, 2013

Healthcare? Worker’s comp? Auto accidents? Slip and falls? Insurers survive and thrive because of their ability to sort the valid from the …

FightFraudAmerica.com went live about six months before the refocusing of two of the fraud-fighting support organizations known primarily by their initials. One …

“TWAPPED BY A TWITTER” It was a rather cool case of working together — and Wanda Lee Ann Podgurski’s twittered taunt of …

REVISTING THE KAITLYN ARQUETTE CASE It’s been nearly two decades since Southern California fraud defense attorney Michael Bush introduced me to one …

By Dennis B. Kass The first step in combating insurance fraud is to recognize that there truly is a problem. Is there …

CERTIFIED DOCUMENT EXAMINERS AND FRAUD Graphology is a combination of the Greek word graphein, which means “to write,” and the suffix “ology, …

By L. Burke Files If you’re part of the John Cooke reading audience, chances are that you work for an insurance carrier, …

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From the Editor

November 25, 2013

Catch as catch can. If you’ve tried to reach me during the day in early summer and we didn’t connect, keep on …

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APPLYING THE LESSONS OF HISTORY By Joseph D. Serio, PhD The story of the Russian “mafia” as told by most will be …

GOTCHA!

August 19, 2013

ALASKA We think that he got off easy. A Russian man, Rustem Mukhametshin, who arrived in the US on a student visa …

IT AIN’T OVER UNTIL THE DOCTOR SINGS They got the pharmacist, “Bob” Patel, RPh, and handed down a Federal District Court sentence …

Understanding the naming conventions of other cultures is important for an investigator or for anyone wishing to certainly and correctly identify people in …

IN CASE YOU EVER WONDERED ….             No Language Family Script(s) Used Speakers (Millions) Where Spoken (Major) …

MEDICAL NOTES HAVE A LANGUAGE ALL THEIR OWN. The Joint Commission for Accreditation of Healthcare Facilities requires that each facility maintain a …

JUST WHEN YOU THINK YOU’VE HEARD IT ALL Identity Theft = two very scary words. Everyone knows those words. Everyone fears them. Everyone …

(YES, WE MADE UP THAT WORD; WHO CARES WHAT WEBSTER THINKS?) As Hurricane Sandy took her toll on the eastern seaboard, she …

SPEAKING OF NAMES… Two of the names from the 90210 (divided by) 31 ( (+ or -) 5 million = 33 (to the …

THE NEW MATH — THE MATH OF FRAUD Now put it into a story problem, sez you! How about this: 90210 resident …

We go all the way to Russia this time and find a Stupid Fraudster, a Smart Driver and an out-of-control situation. Making a …

Humor Corner

August 12, 2013

(We Are Equal Opportunity Offenders)   [color-box color=”blue”] Claims Reps A distraught policy holder called her company to report that her house …

WHEN INSURERS CONSPIRE TO DEFRAUD By Barry Zalma Many individuals were involved in a farreaching and long-lasting scheme to deceive persons about …

One of the best kept secrets is learning how to figure out what groups participate with one another in criminal activity — …

KATHY’S STORY

August 12, 2013

[color-box color=”gray”]No one will dispute that, given the risks involved, a soldier’s paycheck is on the low side. No one will dispute …

BUMP AND BUILD AUTO IMPACTS By William King, Jr. When the Honda vehicle rear ended the Ford vehicle, both sustained only cosmetic …

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WE MAY INDEED BE DOOMED — THREE CALLS THE CHARM By Anonymous Beginning Blood Pressure: 115/72. First Call: To an A+ Best’s …

There’s no doubt about it. When economic times are difficult, the number of claims submitted on stolen/burned cars goes up. The reasons …

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WHEN THE SCALES OF JUSTICE ARE WOEFULLY UNBALANCED A retired-after-31-years-in-the-National- Guard-reservist is going to have three and a half years behind bars …

It might not have a lot to do with insurance fraud, however as responsible reporters the Editors of The John Cooke Fraud …

In the last issue we wrote about Cassie Chadwick, the woman who really should have had the Ponzi scheme named after her …

In an indictment issued by the U.S. Attorney’s Office for the Northern District of Texas, Leroy Nelson could very well be in …

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ASK DOCTOR BOB

August 1, 2013

Healthcare? Worker’s comp? Auto accidents? Slip and falls? Insurers survive and thrive because of their ability to sort the valid from the …

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SIU AND DEFENSE COUNSEL The standard model of the Special Investigation Unit (“SIU”)/Outside Counsel partnership is what you could describe as the …

There was a terrible tragedy in Mark Center, Ohio, in November, 2003. A ten year old boy accidentally shot his own father …

DEFINITELY NOT THE SMARTEST CRACKER IN THE BOX Dauphin County, PA, has an estimated population of 270,000. These Harrisburg area residents include …

In a mid-April announcement, two people are charged with pig-skin fraud. Marcus Buckley, New York Giants linebacker now living in Texas, has …

MISSOURI MISERY When the U.S. Attorney’s office teams up with the Social Security Administration – Office of Inspector General, the Department of …

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From the Editor

August 1, 2013

Nineteen years is a long time. Good old John Cooke is now old enough to go to war (in a way, he …

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DOWNSIZING SIUS – A COST-SAVING MEASURE OR AN OPEN DOOR POLICY By Tommy Short This Shakespeare quote is from a line in …

Understanding the naming conventions of other cultures is important for an investigator or for anyone wishing to certainly and correctly identify people …

Some stories make you want to laugh and cry. For the victim. For the bad guys. This is one of those stories. …

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The arrest took place in December, 2011, but the matter reached the preliminary hearing stage a year later. The accused, Carlos Guzmangarza …

By Barry Zalma, Esq., CFE © 2013 Insurance claims handling is a profession that requires a jack-of-all-trades and a master of insurance …

The saga began on March 27, 2009, when a Tacoma, Washington, man, Yevgeniy Samsonov, was involved in a minor traffic accident. The …

The owner of Texas Durable Medical Equipment Company, Hugh Willet of Fort Worth, was been found guilty of six counts of health …

A recent South Carolina investigation has revealed a case of “Not.” A sure finalist in the “Sickest Frauds in Recent History” competition …

(From long time friend Bob, an SIU-er from Minnesota and a really smart guy. Shared in JCFR with permission of the writer.) …

                    Latin America: An abrazo (hug) or beso (kiss) is a typical …

Neelam (wife) and Sanjiv (hubby) Kakkar are in deep Kakkar. After purchasing the Brookdale Inn and Spa in 2007 for $5.3 million, …

Born in 2006 as a division of Alikim Media (same parent as John Cooke), FFA is among the most extensive fraud education …

If brains were measured in breast size, this lady needed help. In fact, that’s why 23-yearold Amanda Perkins says she dumped gasoline …

This issue’s Stupid Award is a slam dunk. Straight from Stromsburg, Nebraska, comes 19 year old Hannah Sabata — who stunned York …

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PERHAPS THE BEST KEPT SECRET IN INVESTIGATION Si, Senor! En Mexico, Tienemos Databases! Fact: Identity theft is the fastest growing crime in …

Federal law 18 U S C 2511(2)(d) defines the overall right of one involved person to record telephone calls and/or in-person conversations. …

      If you’ve ever wondered what the number and distribution of fraud complaints filed with the FTC in a …

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By Diana McG Having spent more than two decades as an SIU investigator and a claims adjuster, I say with certainty that …

There’s nothing new about fraud. From fake jewels and cleverly plated gold in Phoenician times, all the way to the present, the …

By L. Burke Files There are state laws, local laws, and federal laws all dealing with ID theft, and yet it still …

LAWS

May 1, 2013

Alabama A newly enacted law, Act 12-429 (Insurance Fraud), assigned a Class B Felony Status to frauds over $1,000 and a Class …

The amount of insurance fraud estimated to be occurring in India’s $70 billion dollar a year insurance market is approaching 10 percent …

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By Mike Sankey This article examines public record databases of individuals and companies that have federal sanctions, violations, agency enforcement actions, or …

Debra Gail Hodges of Fayetteville filed a $10,000 claim with Liberty Mutual in the summer of 2011 and included a list of damaged …

By John Garrison There are two approaches to healthcare. Doctor Number One will treat the symptoms. A pill for this, an injection …

By Cowboy Don This is a simple investigative tool that can often confirm the approximate source location of a received mail, or …

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By Leslie Kim In the July/August 1995 issue of The John Cooke Fraud Report, the front page article was entitled, “Inside the …

It can happen to anybody, even the guy who makes prisoners wear hot pink jumpsuits and eat peanut butter sandwiches. Arizona’s toughest …

Targeting Penske, Ryder and Budget rental companies, Berk County residents Jason Jones, Thomas Oliver and an (as yet) unnamed third participant. using …

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Jason Dross of Celina, Ohio, was sentenced to nine months behind bars by the Franklin County Court of Common Pleas after an …

ARIZONA It might be “just” a fraud investigation — or – – it might be a murder investigation. The Department of Public …

Marcus and Beth Jenkins of Farmington Hills, Michigan, were doing “better” for quite a few years; now they are doing “worse.” Each …

Seeking candidates with a wide variety of experience = You will need to replace three people who just left. Problem solving skills …

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Ask Dr. Bob

March 17, 2013

Healthcare? Worker’s comp? Auto accidents? Slip and falls? Insurers survive and thrive because of their ability to sort the valid from …

There are hundreds of medical certifications, degrees, licenses, academies, and (unfortunately) all too many initial combos that combine to spell “I-G-O-T M-Y …

By Mindy Hsu Start in Middletown, New York. Police arrested two men attempting to fill a 180-pill prescription for 30 mg oxycodones. …

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Hello Again, Old Friend

February 15, 2013

If you’ve been in the fraud fighting industry for nearly two decades you might recall when the Premiere Issue of The …

If Allstate has its way in a recent New Jersey Superior Court case, two East Orange Chiropractors are going to have to …

By Leslie Kim Harold Anderson has been a JCIFR subscriber since our very first issue hit the streets. President and CEO of …

At least six states are currently investigating American Family Benefits Group, Inc. (AFBG), marketers of a “too-good-to-be-true” opportunity. For a mere $99, …

Armen Aivazian, owner of the Sayat Nova restaurant in Glendale, California, has been arrested and charged with four counts of felony insurance …

By Michael Diegel The “Report on Workers’ Compensation Outreach Materials,” a study undertaken by the Coalition Against Insurance Fraud, reveals that there …

Angela Tucker Barnes was stabbed at least seven times in the back, throat and face. She was buried late in 1983. She …

Gotcha

January 24, 2013

CALIFORNIA Daniel Trent Bailey hung a shingle and went into business as an insurance broker. Problems arose, however, when motorists who purchased …

From the Editor

January 24, 2013

If the US were to send thousands of troops to Kosovo, but failed to equip them with the latest in weaponry and …

Cleveland, OH; Columbia, SC; Detroit, MI; Houston, TX; Indianapolis, IN; Las Vegas, NV; Little Rock, AR; Los Angeles, CA; Memphis, TN; Miami, …

by L. Burke Files Check fraud and counterfeiting have become the crimes of the 1990s. The US. Justice Department estimates that $10 …

By Barry Zalma Some people act too smart for their own good. They want to commit a fraud but don’t know how. …

By Gary A. Turnberger, CFE, CIFI, SCL and Robin Duranik Those of us involved in the business of claim handling have often …

By Richard P. Boehning Insurance fraud is an annual $20-billion-dollar scourge that bedevils the U.S. property/casualty industry.  Insurance fraud is not a …

Operation Interstate is an ongoing five-month investigation taking place in 11 states and involving 18 Ohio Bureau of Work Comp fraud investigators …

By Ed McArdle Remember just a couple of years ago, when having your own voice mail was the leading-edge business office technology? …

Peter Caputo of San Francisco has a rather unique resume. Not only was he a body builder in the 1970s, one year …

By Thomas M. Bower Many lawyers in private practice, regardless of their years at the bar, often find themselves wondering what clients …

Remember Gary Miller of Encino? He was the attorney who was convicted of participating in a staged auto swoop/squat accident in which …

By Rob Painter, DABFE, ASE, CFL Every day, hundreds of allegedly stolen vehicles are found burned. And every day, some of the …

By L. Burke Files We hear so much about slumlords and how they steal property. Basically, they buy it cheap, collect rent …

By Robert P. Hartwig, Ph.D. The Insurance Information Institute estimates that frauds perpetrated against property/casualty insurers totaled about $21 billion in 1998. …

By Dennis Kass, Esq. INTRODUCTION Imagine a football game where your team never plays offense. For the entire game, you field only …

Joseph Lee Stinson must have liked the extra cash. While he was collecting workers’ compensation temporary total disability payments because of a …

So, what does USAA stand for? How about Understanding Scam Artist’s Attempt? Or Uncovers Scheming At Autoshop? In cooperation with the Pennsylvania …

Joe Trucker opened his mail and found an offer for commercial trucking insurance from Writer’s Direct Incorporated. The prices looked too good …

“Til Death Do Us Part

January 15, 2013

By Leslie Kim The initial contact was by e-mail: from a keyboard in Israel to my computer screen in Southern California in …

Thomas Muglicco of Donaldsonville has been booked on 25 counts of theft and 25 counts of misappropriation of insurance premiums.  Authorities believe …

  By Larry G. Henning, CFE and Edward J. Wilbraham, Esq. In general, the expanded use of video surveillance over the past …

A.  The Insured’s Right to Privacy v. The Insurer’s Right To Investigate Courts have generally encouraged the use of surveillance as a …

California DOI fraud investigators arrested 11 people suspected of insurance fraud, concluding a two-year investigation.  The chief suspect, a former Farmers Insurance …

Dear Sherry

January 15, 2013

Q: I think that fraud is being perpetrated on the fraud-fighting industry. I am constantly getting virus warnings on my computer e-mail …

An elderly man decided to purchase annuities for his four grown daughters and one niece. Because his hands shook so much, he …

If Fall River psychiatrist Kennard Kobrin were to lay down on his own couch and relate his problems, it would take a …

By Wayne R. Centanni, CLI What is a pretext? Simply put, it’s telling a lie in order to receive information from a …

By Barry Zalma There is a disturbing trend entering the law. Judges, jurors and administrative law courts, if convinced that a fraud …

From the Editor

January 14, 2013

Stuff Happens. This issue was all sewed up and ready to print, mere hours from our press appointment, and a request was …

A Federal District Court in Charlottesville has ruled that memos sent by a law firm to its experts are discoverable. The case, …

By Bob Gentile In looking at the basics of fire scene photography, the following question must be answered first, “Why photograph a …

In what could be termed as one of the largest insurance fraud sentences received by a single individual, Tony Lucius Francis has …

California Department of Insurance (DOI) fraud investigators arrested John Charles Haidich of Lafayette and charged him with 69 counts of workers’ compensation …

(Editor’s note: Well, we finally did it … convinced the Computer Search Guru of the Western States to write a column for …

By Warren Wellen I am an attorney who defends and investigates suspected fraudulent claims. I have had many opportunities to review transcripts …

Hundreds, no make that thousands, of people gave a vial of blood in exchange for $30. Upon delivery of each blood sample …

Just head on over to the Philippines. Proceed to Manila, then to a particularly dingy section of Recto Street. While you enjoy …

It took a joint effort by the Maryland Insurance Administration, the Maryland State Police and the Office of the Attorney general, but …

SANTA ANA – Fernando Franco Garcia denied any prior injuries when examined for a recent work-related back problem.  Investigators learned he had …

Editor’s Note: In response to our recent JCIFR article on Viaticals, we received the following additional information from Gloria Wolk, a national …

The memorabilia market boosts the economy by an estimated $1 billion a year. Baseball trading cards, autographed baseballs, autographs of famous historical figures  all …

So maybe it was an unusual situation to begin with, but the government’s handling of the matter was even more unusual. A …

This story probably fits into the category of Stupid Fraudster Tricks. It’s all about 28-year-old Tampa resident Elnetta Denise Brown  we think. …

In February 1999, the California Department of Insurance issued a Cease & Desist order against Alejandro Corral of Downey and Travel Guard …

To those with airline mileage accounts, free flights are right around the corner if you keep up to date on free mile …

Jackson Memorial Hospital was hit by a plague. Something in the air was causing many of the workers to suffer from symptoms …

There may be no more Home Insurance Company policies being issued, but the fight against fraud continues on cases opened by their …

Gotcha!

January 7, 2013

ARKANSAS Investigators determined that arson was the cause of a fire at the Kentucky Missionary Baptist Church in Saline County. They also …

Victor Cortez sold hundreds of auto insurance policies out of his Escondido, California, Auto America Insurance Agency (AAIA). But the buck stopped …

The New York Department of Insurance is now accepting electronic reports of insurance fraud from companies doing business in the state. Using …

After the lack of an Oops, I must have made a teeny-weeny billing error defense, Newton psychologist Lionel Lyon has been ordered …

Puzzle

January 7, 2013

After reading these clues… John Montalbano (Darn smart investigator for GEICO) will be staying at the Wyndham Palace (the site hotel for …

It would include: * 584 Asians * 124 Africans * 95 Eastern and Western Europeans * 84 Latin Americans * 55 former …

Puzzle – TV Tunes

January 7, 2013

Under ordinary circumstances, we’d give you the questions and withhold the answers.  But this puzzle is just too darn HARD if we …

Dear Sherry

January 6, 2013

Dear Sherry Q: I’m working on a bad-smelling auto file where our trucker claimant has drivers licenses in at least three states. …

Oh, oh, oh, oh, oh, oh, yes, I’m the great pretender. Pretending that you’re still around…… What’s around? Why a pretty nifty …

By Jon E. Crosby, CFE, CIFI, FCLS An integral part of the investigator’s or claims adjuster’s role involves the taking of recorded …

Goshawk Syndicate (GS), a London-based insurance underwriter, is screaming FOUL. Basing their agreement to insure the big money prizes given out on …

Gilroy, California, is the Garlic Capital of the World … which has absolutely nothing to do with the fact that Gabriela Gomez …

A burglar broke into a New York eatery in the middle of the night. He treated himself to expensive wine and the …

Harry J. O’Connor, a claimant in multiple Tiffany Lamp property claims over the past several years (no comment!), tried another type of …

Anne Marie Fangonilo of Redwood City, California, was employed as a claims adjuster for the California State Automobile Association. Her job included …

By George Romain, Esq. Insurance company claim adjusters beware: Daubert is about to call on you. A recent US Supreme Court ruling …

 You know the feeling. Like a drug addict craving his next fix, it creeps up. You’d do ANYTHING for a chocolate bar. …

Martha Rosa Olivera of Ceres, California, was advised by the DEA that her vehicle was being seized as a result of a …

 By Barry Zalma, of course The Hungarian owned and operated a Board and Care facility for the aged in Carson City, Nevada. …

 There’s no slowing down in the state of Ohio for WC convictions. A Franklin County grand jury has indicted 12 people for …

 While the California Holocause Insurance Settlement Alliance (CHISA) has not resorted to the word fraud, the allegations in this ongoing saga are …

The Not Smart Pilot In August of 1998, Paul Franklin Ostrove of Hermosa Beach, California, ran out of gas. Unfortunately for Ostrove …

 This issue was hot enough two years ago for the John Cooke Insurance Fraud Report to run a front page story. At …

Credit Card Fraud Drops – The 1999 loss statistics (USA) are in and the picture is promising. Visa reported a record low …

 At this point, the astute claim rep was suspicious.  He also received a call from the Senior U.S. Forest Ranger who was …

By Peter Muldavin Establishing the Need to Prove Past Weather Conditions. Picture the following situation. An insurance carrier has insured the defendant …

By Bill Lundy Something is happening in the insurance fraud world. I hunch it is not necessarily by design that it is …

From the Editor

January 5, 2013

The year was 1974. A large midwestern MGA, operating under retro authority as a full insurance company, ran into financial problems due …

By Leslie Kim It’s inescapable. No place or person holds immunity. Succinctly stated, fraud happens. Even the Editor of the John Cooke …

“Competitive Salary” – We remain competitive by paying less than our competitors. “Join Our Fast Paced Company” – We have no time …

By Donald A. Kohtz Most investigators love the hands-on aspect of investigations and the challenge of catching the fraudster. However, some investigators …

By John Wood Freedom of Information Center http://www.missouri.edu/~foiwww/index.html A good starting point for those looking into “freedom of information” (FOI) matters via …

By George Michael Newman DNA. Blood Spatter. CD ROMs and the Internet: the last decade has generated revolution after revolution in methods …

By Robert von Esch III, Esq. With the expanding use of experts and their hefty fees, creative alternatives should be considered to …

By Rob Painter The following story is fictitious.  It is, however, based on a true story – one which covers a period …

Having trouble with your sales presentations? Want to dazzle your friends at parties? Try working the following facts into the conversation: * …

From the Editor

January 5, 2013

“Daddy, there’s smoke coming out of the garage door…” And so began the saga of how the Editor of an insurance fraud …

From the Editor

January 5, 2013

R1#6%6*%@@MB&K!6*64$2S The preceding is a picture of my brain as I write this issue’s Editor column. This column is always the last …

From the Editor

January 5, 2013

Some things just don’t make much sense. On February 1, 1997, a young family of three was burned alive in a fiery …

From the Editor

January 5, 2013

If you look at the upper right hand corner of this issue’s cover, you’ll see it’s Volume 5 and Issue 1. That …

From the Editor

January 5, 2013

Comedian Allan Ray told a “joke.” He said, “Allstate recently sued 45 doctors, alleging fraud. The physicians are accused of stealing funds …

Ten years ago, no one had heard of a Viatical.  The concept had not yet been born.  People who had cancer just …

Wayne Durfey, an unlicensed contractor from Santa Ana, California, was arrested as a result of an undercover investigation conducted jointly by the …

And we quote (with permission, of course, from Editor Extrordinaire Trevor Jones): Now that the tobacco companies have crumbled in the face …

The words “insane” and “Insanity” are not recognized medical terms; they are, however, recognized legal terms. The initials “B.C.” (Before Christ) are …

Four men have been charged with auto insurance fraud after their alleged plans went sour. On June 17, 1998, Guillermo Sanchez and …

Robert Joseph Benge, Joseph Benge, Joseph Benges, Joseph Bengen, Robert Joseph and Jimmy Flippen – who just happen to be one individual …

Eckerd, a 1,700-store chain based out of Largo, Florida, and owned by J.C. Penney Co., denies the charges. Officials believe that Eckerd’s …

Click on http://www.allianceai.org and tune into a wealth of information provided by the Alliance of American Insurers. Move over tohttp://www.insurancefraud.org and find …

How may we investigate? Let us count thy governmental and law enforcement ways. In alphabetical order, here’s a list of the ones …

When Delta Dental Plan noticed several unusual billings coming from Beverly Hills DDS Julie Valentine, investigators decided to root out the problem. …

On August 23, 1996, Glendale businessman Pierre Lebon Hoffman called 911 for help. He said that he came downstairs in the morning …

By Leslie Kim WARSAW POLAND, OCTOBER 2, 1997: We are very, very far from home. It is evident everywhere; and once again, …

Thinking of expanding your area of business? Considering going international with your services? Looking toward far off places, with dollar signs dancing …

In the summer of 1997, after authorities became weary of the proliferation of organized auto theft rings in south Florida, a multi-agency …

Over 700 fraud fighters gathered recently at the Burbank Hilton to hear the annual “State of the NICB” message. Here are some …

That’s all they bothered to go after:  Porsches, Jeep Wranglers, Mercedes, etc. A routine business inspection at a Santa Ana, California, …

The Crime Problem

January 3, 2013

Numerous complaints were received from private insurance carriers by the San Diego Division of the FBI, as well as other FBI offices, …

Alan D. Bersin, United States Attorney, and William D. Gore, Special Agent in Charge, San Diego Division of the Federal Bureau of …

Rice, Carlos Jose Emanuel Rice that is, was the alleged capper in an auto fraud ring that was recently smashed by the …

By Barry Zalma The insured had no respect for his insurance company. He expected them to pay any claim he presented. He …

“You’re in Good Hands When You Help Out Your Good Neighbor” ought to be the motto for the recent team effort …

It was a paper accident scam that bilked insurance companies out of more than $2 million. And it worked for a while. …

Two recent British Columbia Supreme Court rulings favored the Insurance Corporation of British Columbia (ICBC) in a big bucks way. In the …

Staging automobile accidents and filing false medical claims got Gabriel and Amihan Gonzalez tickets to prison and some hefty fines. After pleading …

Off the Wall Lawsuits

January 3, 2013

Thomas Passmore saw the number 666 on his right hand so he sawed it off. Upon seeing the number, Passmore recalled the …

The Coalition Against Insurance Fraud estimated that $877 million per annum went to fraudsters. In response to the existing problem, and …

By Leslie Kim Lagos, Nigeria. Even the names of the city and country bring forth the vision of a far-away, alien …

California’s legislative answer to the staged accident dilemma may be contained in a newly introduced bill, SB 334. A brief summary of …

By Michael Z. Lighthouse For special investigative personnel charged with educating claims employees, a lesson in back injuries is a good idea. …

Auto theft is the most costly property crime in the nation. Los Angeles County residents have 89,000 vehicles stolen each year, valued …

By Susan E. Clarke Staff Writer In a rather unique scam, criminals are purchasing life policies on beggars, peasants and prostitutes and …

Attention! If your prosecution efforts involved an “expert witness” by the name of Howard Bruce Ollick, you may have a slight problem. …

The recent conviction of Michael Kerr, owner of Kerr Chiropractic Center in Toledo, has proven to be one of the largest provider …

Their paths crossed for the first time about eight years ago.  Bennie Roberts was an illiterate, retired quarry worker, who owned a …

Bobbi Jo Womack was just 18 when she died. The young woman, who had both physical and mental disabilities, was living with …

Don Ray’s Privacy Tip Don’t sue anyone. Remote voice mail. Consider not voting. Don’t enter contests. Get married overseas. Postal services PO …

About three years ago, check counterfeiting began emanating from the Garden Grove, California, area. This location was home to “Little Saigon,” the …

During 1997, Washington is averaging about 10 bank robberies per week, most occurring in the Seattle area.  Only California, Florida, New York …

Theresa Watkins has been sentenced to nine years in prison following convictions on a dozen years’ worth of fraud. Watkins was involved …

By Ira T. Deutsch During the first week of March 1997, my company was exhibiting at the California Self Insurers Association convention …

By Michael Bush House Bill 1620 literally flew through the Washington Legislature, passing unanimously before heading to the Senate with the same …

WebSPIN

January 3, 2013

By Dorothy Montague Do you travel a lot?  Or perhaps you are planning to open a small business and don’t want to …

By Byron Bales and Diane Kellner When it comes to reports of American citizens who have died abroad, the answer to the …

By Daniel R. Brownlee Although there are more than a dozen independent states lying along the eastern coastal area of the African …

Two Worcester attorneys, partners in one of Massachusetts largest workers’ compensation law firms, were recently indicted along with five of their clients …

In May of 1991, Thongkam Somsanuk purchased a $500,000 life insurance policy from the Metropolitan Life Insurance Company office in Alexandria, …

By Byron Bales China is rapidly becoming more accessible to outsiders. Just a few years ago, those who wanted to visit China, …

This issue’s “nasty” goes to Smart Medical Alert Systems (SMAS) of Pompano Beach, Florida.  After more than 90 complaints, the attorney generally …

By Robert Scott Sr. An aspiring Hollywood Starlet suddenly files a sexual harassment suit against a producer, claiming to have been the …

The Pelonomi Hospital is located in Free State, South Africa. A major mystery had everyone abuzz. Every single Friday morning, for …

The Southeast Regional Sting Project (SRSP) was an 11 month long multi-agency undercover task force aimed at penetrating the stolen property network …

Okay, we confess. The following story really has absolutely nothing to do with insurance but it’s just one of those tidbits that’s …

The Insurance Fraud Division of the Maryland Insurance Administration and the National Insurance Crime Bureau have announced that a Prince George’s …

Following a three-year joint undercover investigation by the California Insurance Fraud Department and the Santa Clara County District Attorney’s Office, five members …

By Barbara Clark Suicide is the ninth leading cause of death in the United States: on the average, one person dies by …

In Oakland Park (Broward County), owners of West Dixie Enterprises were arrested stemming from an investigation that discovered nearly $10,000 in …

By D. J. Osborne “Can you imagine making a year’s income in a month’s time? Would you like to know how to …

By Joan E. Feldman The growing use of electronic mail and other electronic evidence in litigation is having a profound effect …

Combining a PC and a video camera, video conferencing will give the insurance adjuster – and the claimant – real-time, face-to-face access …

By Dan King Differing needs in claims investigations may cause a dilemma for fraud units. While the insurer generally prefers that all …

Lisa Carver, a young blind woman, thought she had found the man of her dreams. He was a young retired dentist; he …

The Los Angeles Twin Towers Jail is supplying lodging to Mei-Ling Huang, described by some of her victims as the “house guest …

By Judy Anderson, J. D. I work in an applicant/plaintiff medical clinic. Like many people on this side, we are legitimate. Unfortunately, …

Harry Brainless (the names have been changed to protect the not so innocent) purchased a brand new Jeep Grand Cherokee with the …

The statistics are alarming. Car theft cost $8 billion nationally last year.  Almost two million vehicles are stolen each year in …

A Tarrant County grand jury has indicted Donald Ray Carlen of Bedford and his father, James Glendale Carlen of Fort Worth. The …

By Michael McLarney John Williams was stopped at a traffic light in his employer’s delivery van. He was looking to his left, …

HE: David Carter, age 49; former Atlanta restaurateur, dogged by the federal government for many years; moved to Moscow just prior to …

Richard “Rick” Adams either had some stunning connections or a lively imagination.  His purported lies included the one about his grandfather being …

When investigators compared the accounts to locate the point of compromise (POC), they found that each card in question had been used …

Andrew S. Pitts, according to many, had it all.  After graduating from DePaul University Law School in Chicago, Pitt  worked as …

Tully Plesser is heading off to serve a federal prison sentence. He also has the distinct honor (?) of holding a …

First there was the Better Life Club of America, Inc. (BLC).  All one had to do was invest some money (usually from …

(The following article is reprinted from FRAUD FOCUS, the publication of the Coalition Against Insurance Fraud) A privacy bill introduced by Senator …

Big lenders are experiencing success with a new program that links them up with the Internal Revenue Service for the purpose of …

It’s a fascinating case. There’s a missing person (assumed dead, but no body has ever been located); a rogue suspect who …

It’s clearly a case of he says, he says. Residents of Charlotte are divided as to what really transpired on January 1,1996. …

Editor’s Note: These gems have been making the fax machine rounds for years. We print them here for your amusement… “A pedestrian …

By Larry Burke What follows is a frightening story; what makes it truly frightening is that it really happened. On a recent …

By Howard Goldblatt Since it’s that time of year, when we start thinking of summer and the end of school, we thought …

From Florida – Advisory of Bank Fraud Against Senior Citizens. The Orlando Police Department and Orange County Sheriff’s Office are beginning to …

REPRINTED WITH PERMISSION X-FILE BACKUP:  SPACE CULTISTS LOSE GRIP The underwriter that insured the 39 Heaven’s Gate cultists who committed suicide last …

By Dr. Alexander Gorkin Editor’s Note: I had the opportunity to meet Dr. Gorkin when I traveled to Moscow in late 1995. …

Thirteen people were indicted by a federal grand jury for operating bogus medical clinics to treat bogus injuries from bogus automobile accidents. …

According to a survey done by the International Financial Law Review and reported in London’s Guardian, lawyers in London are the highest …

Allen Leslie Brinkley of West Palm Beach told an undercover Florida Department of Law Enforcement (FDLE) agent that he (Brinkley) had been …

As rings go, this was a giant. An estimated 1,000 people participated more than one percent of the city’s adult residents. A …

On a recent trip to “Nawlins” (as anybody who knows anything pronounces it), I had the opportunity to sit down face-to-face with …

Recently released research results and statistics confirm that credit card fraud knows no geographic boundaries. The European Union (EU) has a massive …

Physicians are frequently placed on a social pedestal by most segments of society. As patients, we are at our most vulnerable when …

The Association of Certified Fraud Examiners recently circulated the 1996 Report to the Nation on Occupational Fraud and Abuse, the largest privately …

By L. Burke Files So often we view those people with offshore accounts as “suspicious” by definition.  But any good investigator must …

Authorities believe that Jerome King Talley’s most recent scam started at a Forest Park High School meeting when attendees were asked to …

If you’re reading this in Kansas and you’ve got an opening for a trainee, might we suggest you track down the guy …

The American Bankers Association is circulating information on the new $100 notes issued in March 1996. Printed flyers suggest looking for the …

The purpose of this article is to familiarize the reader with the common security features of travelers checks, simple methods of detecting …

By Michael Kessler You’re in an enormous warehouse, filled with thousands of garments bearing the names of all the top designers: …

By Trevor Jones Sometimes, more goes missing than can be believed. Lloyd’s was hit with a spate of coffee related claims from …

According to a survey by the Association of British Insurers (ABI), British fraud levels fell for the fourth year running in 1996. …

By G. Andrew Nagle History tends to repeat itself in the fraud business, sometimes tragically. On June 17, 1992, in the midst …

Excerpts from a recent report from California Attorney General Dan Lundgren:  Russian organized crime has grown rapidly over the last five years, …

Richard Lee Hamrick chose an odd head-covering to use while robbing a Seattle area Safeway Supermarket … a pair of bikini …

Philadelphia District Attorney, Lynne Abraham, United States Attorney, Michael Stiles and Postal Inspector In Charge, Bruce Chambers, announced the return of a …

MedLaw is the code name for a statewide investigation, initiated by Sacramento based agents of the FBI, the IRS and the California …

Tampa police are searching for a pair of identity-stealing crooks who have been on quite a shopping spree lately. Their MO is …

Five fraudsters had a pretty unique scam operating out of the St. Tammany Parish area. They would hold phony job fairs – …

The United States.  Paradise.  Land of opportunity.  A new life for Russian immigrants lucky enough to come here.  Alexander Shindman, 30, …

By Susan E. Clarke The first insight into this issue’s Man Behind The Mystique comes from the telephone. When I call him, …

By James “Rick” Youngblood CFE Corporations throughout the world are faced with the problem of dealing with ethical violations by those in …

By Charles Pfeister With the explosion of data sources available on the Internet, most investigators are aware of the great potential of …

Behind the Gypsy Mystique

December 31, 2012

Editor’s note: According to the American Heritage Dictionary, “gypsy” is defined as “One inclined to a nomadic way of life.” In the …

By Barry Zalma This One Isn’t Fiction Because No One Would Believe It My call, in the March 3, 1997, edition …

Here is a condensed guide to drivers licenses in all fifty states and the District of Columbia. We’d like to thank the …

Expired licenses. Do not accept an expired license as identification. Uneven surfaces, especially by the picture or the birthdate. This may indicate …

When the Federal Trade Commission convened a meeting of industry, consumer groups and government regulators to address the problem of identity fraud, …

Twelve years and $1.1 billion later, a former trader for Daiwa bank is convinced he has finally done the right thing. “I …

The immigration services business was a darn good front. The operators of the business were able to glean employment information from their …

By Barry Zalma His parents escaped the pogroms of Eastern Europe and moved to Syria in the early 1930s. Through hard work …

Imagine how you would feel if you found out someone else was using your identity. Now imagine how you would feel …

In a crackdown against a new breed of investment scams, through both tele-marketers and the internet, Canadian and US authorities are …

A jury in federal district court in Miami, Florida, returned a verdict of $2,930,458 in favor of Liberty Mutual Insurance Company. The …

On the ladder of international organized crime, drug trafficking ranks number one. In second place, and sneaking up fast, is auto theft. …

Michael Kelleher, formerly an adjuster with Chubb & Son Federal Insurance Company in Long Island, New York, may have moved a few …

Hot Tips

December 31, 2012

From Jim Cronin of GEICO: A great question to ask an insured in questionable property claims: “Have any of the documents you …

Doctor’s Chart Bloopers

December 31, 2012

Patient has chest pain if she lies on her left side for over a year.  On the second day the knee …

By Barry Zalma Reprinted with Permission The claimant wore thick lens plastic eyeglasses. He literally fell into a life of fraud. …

The date was January 17, 1994, and the place was Van Nuys, California. Suddenly the earth began to shake and rumble. Some …

From the Editor

December 31, 2012

Early in the 90’s, back in my corporate America days, some home office AVP decided that our company needed a “community presence.” …

From the Editor

December 31, 2012

We’ve said it before; we’ll say it again. Nobody is immune when it comes to financial shenanigans. Most unfortunate, however, is the …

Q: Did you not attempt to sharpen any image? A: Yes no. Did I not attempt? Q: Did you attempt? A: Yes, …

By Byron Bales China is rapidly becoming more accessible to outsiders. Just a few years ago, those who wanted to visit China …

The state of Florida spends an estimated $6.7 billion annually to provide health care to 1.6 million people on welfare or …

By Tim Bullock It’s that time of year.  The approach of winter weather and the yearend holidays coincides with what has become …

By Robert K. Cofod At a recent BAI conference on fraud prevention, a senior representative from a megabank related that his bank’s …

From the Editor

December 31, 2012

It’s a bittersweet victory when I suddenly become cognizant of a great truth that’s been right in front of my nose. On …

From the Editor

December 31, 2012

I remember the scam well.  Everyone was talking about it. “Did you hear about the guy who programmed the bank’s computer to …

The story reads like so many others throughout the USA: authorities extensively investigated a suspicious situation. It began with an automobile body …

FBI Orders Pizza

December 31, 2012

No guarantees on the validity of the following. It’s one of those anonymous fax things and we’re printing it for entertainment value …

Flip, Flip, Flip…

December 31, 2012

UPS believed they had a big, big problem. Individuals were receiving packages with racial slurs and epithets. Inside some of the packages …

By Richard Stutheit Ten percent of all claims are said to be fraudulent in nature. Recent studies have put the level of …

Florida resident Rosemary Doherty had an $8,000 limit on her credit card. One of the last purchases charged to the card was …

By Michael Diegel It’s been gratifying to see that a number of states have moved quickly on an anti-fraud agenda during the …

On to 1997 … NAIC Planning Busy Year The anti-fraud committee of the National Association of Insurance Commissioners is moving forward on …

Late last year, four San Mateo Sheriff’s Deputies met with area SIU representatives and threw four names out in front of them. …

Now that we’ve got your attention… Eight members of an insurance fraud ring were arrested for their alleged involvement in surgically stripping …

RIVERSIDE Investigators from the California DOI Fraud Division and the Riverside DA’s office arrested 23 medical professionals and office personnel and raided …

Membership in the Oregon-Idaho AAA Auto Club numbers 570,000.  The club provides emergency road service, travel information and a traveler’s check banking …

By Anthony Zammuto When selecting a surveillance or special investigation vendor, the decision maker will typically speak with a sales representative, look …

By L. Burke Files Check fraud and counterfeiting have become the crimes of the 1990s. The US Justice Department estimates that $10 …

Editor’s Note: Here’s an interesting tidbit gleaned from the Smith & Brink Report (Free to the fraud fighting industry contact Dan Wood …

After almost ten years of no luck at catching up to fugitive David Brian Williams, the FBI took an unusual step and …

The Colorado governor has signed a bill that should serve as an example to other states around the country.  Auto body …

Perhaps no one is safe any longer. In a scheme that a US District judge called bizarre and incredible, Christians from Maine …

By Anne Silver Conway, M.S., M.A. Handwriting examination can be a valuable tool in the investigation of fraud; however, the field of …

By Howard Goldblatt The 1997 legislative season is shaping up as the most active ever in terms of initiatives affecting insurance fraud …

In an effort to thwart the perpetration of fraud in advances and credit applications, the Reserve Bank of India (RBI) has …

At least $2 million in credit card proceeds is believed to have been funneled out of the US, and one of …

It wasn’t quite the Tommyknockers, but too close for comfort to the laid back town of Clearwater. James Hootman was an insurance …

By Shirley Eileen Fitzgerald, RN Consider the case of Mr. Myers, a 45-year-old, white, male executive, hospitalized following an important business lunch …

In one of the largest crackdowns on insurance fraud in the state’s history, Florida insurance fraud investigators went looking for 63 suspects …

By Barry Zalma The story that follows is based on fact. The names, places and descriptions have been changed to protect the …

It was a durable medical equipment (DME) scam with a slight twist in the recipe. Two of the main ingredients were a …

By: Robert A. Von Esch, Esq. The Examination Under Oath (E.U.O) is a proactive and cost-effective tool to defeat false, fraudulent and …

From the Editor

December 31, 2012

Some readers have recently been surprised to hear our telephones answered “Alikim Media.” A few have even hung up, thinking they reached …

From the Editor

December 31, 2012

John Cooke, the little scrap(per) who came rushing headlong into the insurance fraud fighting world in May 1994, is celebrating his second …

From the Editor

December 31, 2012

I sit at a large, brown, wooden desk with a large gouge in one of the drawers. The desk cost $40.00 and …

From the Editor

December 31, 2012

A special thanks to those of you who choose to go both ways: Both ways that is when it comes to subscribing …

So there I was, Madame Editor, sitting at my desk, minding my own business, not messing with anybody. And there she was, …

Communicating On The Web

December 31, 2012

by John H. Wood Switchboard (URL: http://www2.switchboard.com/), World Yellow Pages NETwork (URL: http://wyp.net/) and BigBook (URL:http://www.bigbook.com/) are free nationwide residential and business …

The California Department of Insurance (DOI) has announced that it will soon begin conducting performance audits of all special investigation units (SIUs). …

By Dennis B. Kass The endless hours of charting, linking and performing computer searches have finally paid off. After months of investigation, …

Orange County District Attorney Michael R. Capizzi announced that a Garden Grove physician has been convicted of insurance fraud and conspiracy to …

By Russell B. Merlette Insurance companies tend to be very departmentalized. It is often the case that the claims handlers and personnel …

Cranston, Rhode Island, police officer Kevin Grant and Tara Devoren, his former girlfriend, tell completely different stories of events that transpired beginning …

Already the fastest growing part of the Medicaid-funded health care system, state and federal outlays in the home health industry have ballooned …

As a result of limited administrative resources, most insurers rely upon the basic integrity of the provider population, paying claims prior to …

While the vast majority of health care providers are honest, health care is a big business; and big business without regulatory and …

California installed some get-tough-on-fraud laws and one that took effect in 1992 just paid off. Several insurance companies are cheering the Superior …

When hiring translators for recorded statements, depositions or other legal proceedings, take the time to thoroughly check the credentials of the individual …

By Ira T. Deutsch During the first week of March 1997, my company was exhibiting at the California Self Insurers Association convention …

Editor’s Note: Every investigator has a favorite story; something that happened in the course of an investigation that was unexpected, enlightening, entertaining …

Americans are generally more willing to see people prosecuted for insurance fraud than they were five years ago, though wide gaps still …

In this issue, beginning on page 7, you’ll find a discussion on the “proper” way to run an SIU. Because we believe …

Live in Texas? Wanna be a risk manager? An insurance agent? An adjuster? A title company escrow officer? A life insurance counselor? …

From the Editor – In the November/December issue, we ran the story of The Nine-Fingered Dentist. It concerned a multi-million dollar insurance …

Fraudbusting 101

December 30, 2012

Physical Therapy: Terms and Definitions Accepted Standard of Practice The following documentation requirements constitute the accepted standard of practice in providing physical …

By Barry Zalma The insured grew up with his wealthy parents on the shores of San Francisco Bay in Marin County. He …

Just when we finally learned to spell his name, Al Toczydlowski (former chief of the Philadelphia District Attorney’s Insurance Fraud Unit (PDAIFU)) …

Once upon a time there was a grown man named Teddy. The mechanic at the Hometown Auto Repair Shop gave Teddy some …

Senitila Taylor was described by one attorney as “death waiting to happen.” Although only 22 years old, she suffered from a heart …

The scam smelled an awful lot like one from California. Picking out a victim in a late-model car, getting into position just …

Perhaps his yearly salary for teaching emotionally disturbed children just wasn’t enough? Maybe he simply grew tired of his 1991 Chevy Blazer? …

By Brian C. Jayne Three weeks ago Joe Smyth submitted a theft claim for his 1990 Camaro and he is anxiously waiting …

The federal government has awarded the prestigious “Department of Health and Human Services’ Award” to one of the Tennessee Bureau of Investigation’s …

Okay, what do the following people have in common? Barry Zalma, JCIFR columnist, attorney, author; Jerry Treadway, Acting Bureau Chief of the …

A Tarrant County grand jury has indicted Donald Ray Carlen of Bedford and his father, James Glendale Carlen of Fort Worth. The …

Gotcha!

December 30, 2012

CALIFORNIA Timothy Chee of San Francisco and Tommy Ho Chi Mak of Daly City figured out how to make a tasty income: …

A Nashville man, Mark Jones, opened an account at NationsBank of Hendersonville with a $50 cash deposit. As is usually the case …

Stupid Fraudster Tricks

December 30, 2012

No question about it. This issue’s top SFT award just has to go to Dr. Oludare Wilson. Nobody else could possibly even …

Gotcha!

December 30, 2012

ARKANSAS An attorney is going Whitewater rafting – straight down the river to prison. Eugene Fitzhugh pleaded guilty to charges of trying …

The number of arrests suspects charged by the District Attorney’s Insurance Fraud Unit for 1997 has already surpassed 200. Included in the …

By Judy Anderson, J.D. I work in an applicant/plaintiff medical clinic. Like many people on this side, we are legitimate. Unfortunately, we …

Bobbi Jo Womack was just 18 when she died. The young woman, who had both physical and mental disabilities, was living with …

By Richard Stutheit Ten percent of all claims are said to be fraudulent in nature. Recent studies have put the level of …

From the Editor

December 30, 2012

It’s a bittersweet victory when I suddenly become cognizant of a great truth that’s been right in front of my nose. On …

From the Editor

December 30, 2012

This issue marks the end of our third full year of publishing The John Cooke Insurance Fraud Report. To those of you …

From The Editor

December 30, 2012

Life—and business—is all about learning. And we in the fraud-fighting industry are privy to a never-ending flow of lessons. I have a …

From The Editor

December 30, 2012

Alikim Media began publication of The John Cooke Financial Fraud Report in August 1996. Similar in format to The John Cooke Insurance …

By Jim Cronin Buying software to aid in investigations is analogous to going to the local supermarket to buy a quart of …

Introduction Fraud investigation can be difficult, challenging and time consuming. Those engaged in fraud obviously try to hide it, and the investigator …

No question about it. This issue’s SFT column recognition belongs to William Angus Barter of Oregon. Police cited Barter for forgery in …

Stupid Fraudster Tricks

December 30, 2012

No question about it. This issue’s SFT column recognition belongs to William Angus Barter of Oregon. Police cited Barter for forgery in …

Stupid Fraudster Tricks

December 30, 2012

An amorous burglar dialed himself into the hands of the police while robbing a Belgian soccer club. Apparently, he used the club’s …

A jury in federal district court in Miami, Florida, returned a verdict of $2,930,458 in favor of Liberty Mutual Insurance Company. The …

The immigration services business was a darn good front.  The operators of the business were able to glean employment information from their …

During a recent trip to London, we (Associate Editor Susan Clarke and myself) ate at many different restaurants. On the last evening …

It is not clear when banana peels were first transformed from fruit casings, or the occasional prankster’s prop, into instruments of a …

Sacramento – At least 36 people have been arrested and more are sought after a two-year investigation into what Department of Insurance …

Bad checks, also known as NSF checks, bounced checks, rubber checks, etc., can be a big problem for any credit department.  There …

Money lost by auto insurers is estimated in the $2 million range. But now, thanks to the work of the Operation Smash …

When the swindled clients began looking for their money, the pathway was framed with lies, deceit and dead-ends. Donald Marquis Bickerstaff, age …

 By Jay Langford Auto accidents are the house specialty in many Vietnamese American law offices. Most insurance companies with auto policies have …

San Antonio based USAA and Longwood insurance adjuster, Fleet Financial Corporation, are settling a lawsuit in which USAA has alleged Fleet committed …

EVERYTHING YOU ALWAYS WANTED TO KNOW BUT WERE TOO BUSY TO ASK – Bunco Schemes There are almost as many Bunco Scheme …

It sounds just like the plot of a Hollywood movie. A gang of crooks, responsible for the theft of more than 280 …

She sobbed loudly and begged the judge for leniency. She spoke, from her wheelchair, about the infant son waiting for her …

When the new tenants arrived with a truck full of furniture and a receipt for the first month’s rent on the …

By Bill Kizorek and Scott Finger You, the witness, are the centerpiece. All are gathered to hear your story so that facts …

With a stated objective of “making MasterCard the safest way to pay,” the credit card company recently announced it would be …

This November, police in Brea, California, really had something to be thankful for. At 7:00 AM on the day before Thanksgiving, …

It is a problem that has reached global proportions. A 1996 Lexus is not safe; a 1973 Pinto is not safe. And …

According to the petition of Missouri resident Joyce Lehr, who is suing the county because she fell in an icy, unplowed …

Between May and October, approximately 100 admission forms were stolen from two San Francisco area medical centers. Summit Medical Center in Oakland …

In its fifth year of operation, Fraudnet scored another win in the war against fraud. California’s State Compensation Insurance Fund, the state’s …

By Linden Management I have been traveling to Nigeria regularly since 1989 and have experienced many unusual scenarios. In May 1994 …

Investigators with online capabilities can go alias hunting, which often leads them to uncover related but otherwise undetected injury claims. An …

The Texas Bankers Association (TBA) has released some GOOD news for a change. Since the start of a program requiring fingerprints …

World Currency

December 30, 2012

One of the problems encountered when dealing with currencies from other countries is understanding the differences between these currencies. Those intent on …

Leonard L. Cole, a Tampa resident, had a little bit of surgery that enabled him to change his name to LaTarsha …

Gregory Gene Shell, operator of Panterra Numismatics in Dallas, is heading toward a Texas federal pokey. He faces a maximum term of …

The Florida Board of Medicine has been cracking down on doctors recently.  Dr. Taj Pal Singh Jowhal has had his medical licensed …

By James “Rick” Youngblood, CFE In today’s security intensive business environment, organizations must rely on a variety of security devices to protect …

By Leroy Cook Investigators in the United States vary greatly from one another in their backgrounds, competency, size of business and, yes, …

The State of New Jersey, under fire by The Chiropractic Alliance of New Jersey, recently agreed to settlement of a federal …

Unemployment insurance is big business in Canada — $13.5 billion per year to be exact. And the system, according to those in …

Combining the talents of investigators from the California Department of Insurance, the Los Angeles County District Attorney’s Office, the National Insurance Crime …

He had feelers out everywhere. He had deals, big deals, cooking. He was charming, witty, smart, personable and told a great …

By Bradley Sanders Several years ago, a group of Colorado business owners developed an advertising and promotion program known as “Always Buy …

REPRINT FROM THE INTERNATIONAL ASSIGNMENT ADVICE NEWSLETTER The Association of Certified Fraud Examiners recently circulated the 1996 Report to the Nation on …

After two Florida insurance executives from Aanco Underwriters were found guilty, it came time to pass sentencing. The men had been charged …

By Barry Zalma Aunt Susie had been in the restaurant business all her life. She worked for chains like Denny’s and Stuckey’s. …

By Susan E. Clarke Staff Writer The following letter came addressed to me. Not to occupant or resident, but directly to me, …

By profession, he was a company savior, a guy who specialized in taking over ailing companies and performing miraculous turn-arounds. He’d …

In 1994 Congress requested a Fed survey on the prevalence of check fraud. The results of the ensuing survey were released in …

San Diego County, a place where hundreds of people have been victimized by fraudulent real estate transactions, is taking some action to …

It’s bad enough when your credit card is stolen; but what do you do when the thief steals even more? What can …

Public adjusters, like personal injury lawyers, work on a contingency fee. For a percentage of the recovery, they present claims on …

$ale of the Century

December 30, 2012

By Ed McArdle Fraudsters, thieves and con men of all types love rental cars and the companies that rent them: what scamp …

The courts are going to have to decide the issue: one that can change the future of controlled disbursement banking. Available to …

Year End Wrap Up 1996 proved to be a successful year in the legislative arena for action on a number of state …

A high-living husband and wife team could face up to 310 years in jail and $310,000 in fines – each – …

In a series of indictments returned by the state grand jury, 12 people have been charged with forgery, theft and filing …

It was a darn good scam – while it lasted. Brothers Norris “Mickey” Melancon and Robin Melancon have been carted off …

A federal grand jury in Lafayette has indicted four men in the latest scandal to hit the video poker industry. According …

In an attempt to stem future “Off The Wall Lawsuits” making it into the pages of The John Cooke Insurance Fraud Report, …

In 1988 Barton (Barry) Greenberg was sent to prison for six years and eight months following his conviction for embezzling $44 million …

John Jaffey was a Toronto wills and real estate lawyer. He had a wife and three children; his father was a …

Colonial Realty Co., owned and operated by the father-son team of Benjamin J. Sisti and Kevin P. Sisti, crashed to the …

Maybe it’s the terrific weather; maybe it’s the sandy beaches and ocean views; maybe it’s a fluke. San Diego, known as …

Corning Clinical Laboratories, a New York-based corporation, reported revenues of $1.6 billion in 1995.  The government is now going to take a …

By Susan E. Clarke Coleman Allen died of heart failure and hypertension on April 6, 1996. While his family and friends may …

It’s a scheme that’s been around almost as long as check transactions. There’s nothing new about it and people still get …

Roweshea L. Burruss’s biggest claim to fame is that he’s an associate of Washington Mayor Marion Barry; his biggest claim to …

Just over two years ago, in June 1994, National Medical Enterprises, headquartered in Santa Monica, California, pleaded guilty to seven felony …

It had all the twists and turns of a grade B movie.  Husband and kids go away for a day, mysterious …

It is a story that reaches halfway around the world. The two main players are Saeb Salaam, formerly the prime minister of …

The US government has reached an agreement with First National Bank of Bar Harbor after a four-year investigation into the bank’s …